Healthcare Provider Details

I. General information

NPI: 1356345300
Provider Name (Legal Business Name): FERDINANDO CORTESE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 S SAWBURG RD STE 110
ALLIANCE OH
44601-5905
US

IV. Provider business mailing address

885 S SAWBURG RD STE 110
ALLIANCE OH
44601-5905
US

V. Phone/Fax

Practice location:
  • Phone: 330-829-4234
  • Fax: 330-829-4209
Mailing address:
  • Phone: 330-829-4234
  • Fax: 330-829-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35054338C
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number0H35-05-4338C
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: